Are Energy and Protein Intakes Lower Than Requirements in Older Adults? An Urgent Issue in Hospitals and Nursing Homes

Abstract

Energy and protein intakes lower than requirements are associated with worsening health outcomes. Here we set out to evaluate gaps between energy and protein intakes and requirements in older adults in hospitals and in nursing homes (NH). A cross-sectional study included 360 inpatients and residents aged 75 years and older in two acute care wards; i.e., a multidisciplinary care unit (MCU) and a geriatric care unit (GCU), a geriatric rehabilitation unit (GRU), and two NH. Intakes were measured for three days. Requirements were based on French National Health Authority recommendations. Energy and protein intakes were under the minimum requirement of 30 kcal/kg/day and 1.2 g/kg/day in 89.5% and 100% of MCU patients, respectively, 75.5% and 64.2% of GCU patients, 92.7% and 90.9% of GRU patients, and 83.8% and 83.8 of NH residents. Intake-to-requirement gaps were not significantly associated with malnutrition, except in the GCU group where non-malnourished patients had higher energy gaps than malnourished patients. Intakes fell dramatically short of requirements in older adults in both hospital and NH settings irrespective of malnutrition status. A new paradigm based on a patient-centered approach should be developed to adapt meals served in hospital and in NH.

Measures for Identifying Malnutrition in Geriatric Rehabilitation: A Scoping Review

“…Of these, 87 articles were eligible for full-text review. After excluding 31 more publications, 56 were included in this scoping review [ 5 , 6 , 7 , 8 , 13 , 21 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 , 32 , 33 , 34 , 35 , 36 , 37 , 38 , 39 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 , 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 63 , 64 , 65 , 66 , 67 , 68 , 69 , 70 , ...…”

“…The characteristics of these studies are summarized in Table S3 . There were twenty-eight cohort studies [ 6 , 7 , 8 , 13 , 24 , 29 , 32 , 33 , 34 , 35 , 37 , 43 , 44 , 48 , 50 , 54 , 56 , 57 , 58 , 59 , 60 , 61 , 62 , 65 , 66 , 67 , 68 ], twenty-one cross-sectional studies [ 21 , 27 , 28 , 30 , 31 , 36 , 38 , 40 , 41 , 42 , 45 , 47 , 49 , 51 , 52 , 53 , 63 , 64 , 69 , 70 ], three intervention studies [ 25 , 26 , 71 ], two meta-analyses [ 5 , 22 ], one case–control study [ 39 …”

“…Fifteen studies used nutritional assessment tools, of which ten used the MNA [ 5 , 13 , 24 , 25 , 27 , 31 , 42 , 47 , 57 , 70 ], five used the SGA [ 21 , 29 , 59 , 66 , 67 ], and one used the PG-SGA [ 13 ]. Regarding diagnostic criteria for malnutrition, twelve studies used the GLIM criteria [ 6 , 40 , 41 , 44 , 50 , 51 , 53 , 54 , 55 , 65 , 69 ], seven used the European Society for Clinical Nutrition and Metabolism (ESPEN) criteria [ 6 , 7 , 28 , 33 , 39 , 46 , 51 ], and two used the International Classification of Disease, Australian modification version (ICD-10-AM) [ 13 , 35 ]. Three studies used composite criteria of both body weight and weight loss, deemed nutritional screening tools [ 23 , 63 , 64 , 72 ].…”

“…Among these investigations, seventeen used nutritional screening tools (thirteen utilized the MNA-SF [ 8 , 27 , 30 , 32 , 35 , 37 , 39 , 49 , 56 , 58 , 60 , 61 , 62 ], one used the Short Nutritional Assessment Questionnaire for Residential Care [SNAQ RC ] [ 68 ], and three others utilized combined tools [ 25 , 63 , 64 ]). Twelve studies used nutritional assessment tools (seven utilized the MNA [ 5 , 13 , 24 , 27 , 31 , 47 , 70 ], four utilized the SGA [ 21 , 59 , 66 , 67 ], and one utilized the PG-SGA [ 13 ]), and twenty-two studies used diagnostic tools for malnutrition (twelve utilized GLIM criteria [ 6 , 28 , 40 , 41 , 44 , 50 , 51 , 53 , 55 , 65 , 69 ], seven utilized ESPEN criteria [ 6 , 7 , 33 , 39 , 46 , 51 ] and two studies, which analyzed identical datasets, utilized ICD-10-AM [ 13 <...…”

“…The characteristics of these studies are summarized in Table S3. There were twentyeight cohort studies [6][7][8]13,24,29,[32][33][34][35]37,43,44,48,50,54,[56][57][58][59][60][61][62][65][66][67][68], twenty-one crosssectional studies [21,27,28,30,31,36,38,[40][41][42]45,47,49,[51][52][53]63,64,69,70], three intervention studies [25,26,71], two meta-analyses…”